Our Interdisciplinary Approach
At Roswell Park, we believe that diagnosing and treating multiple myeloma requires input from experts in different fields of oncology. Our tumor board brings together specialists from several departments to identify the best diagnostic and treatment approaches for every single patient. In cases where standard treatment options have failed, we try to find new targets of therapy to provide additional treatment options.
We work closely with the Cancer Survivorship and Supportive Care Center and Rehabilitation Therapy and Wellness Services teams to ensure that our patients enjoy the highest quality of life. A team led by Jens Hillengass, MD, investigates ways of better evaluating quality of life and learning how to improve this important part of the patient experience.
Roswell Park has launched three clinical trials of immunotherapies for multiple myeloma, with a fourth expected to open in early 2019. Read our blog to find out more information.
Treatment Options
Treatment for multiple myeloma can include systemic (whole-body) options, such as proteasome inhibitors, immunomodulatory drugs, antibodies, histone deacetylase inhibitors, chemotherapy, radiation therapy, stem cell and bone marrow transplant or a combination of methods. In addition, radiation therapy, balloon kyphoplasty and vertebroplasty are used to treat painful bone disease.
The choice of treatment depends mainly on how advanced the disease is and whether or not you have symptoms. If you have multiple myeloma without symptoms, you may not need cancer treatment right away. In that case, you may have what is called smoldering myeloma, and your doctor will monitor your health closely so treatment can start if you do begin to have symptoms.
If you already have symptoms (CRAB criteria) or markers that indicate a high risk for progression (specific blood, imaging and bone marrow results) you will likely receive induction therapy, which uses combination therapy to cause remission, reducing the cancer cells in your body significantly. Often a stem cell transplant is part of the treatment plan.
Because standard treatments do not always control the cancer, eligible multiple myeloma patients should consider the option of enrolling in a clinical research study of promising new treatments that are not widely available.
The Myeloma team at Roswell Park follows the Clinical Practice Guidelines in Oncology™ developed by the National Comprehensive Cancer Network (NCCN). Jens Hillengass, MD, our Chief of Myeloma, serves on the NCCN panel of experts that develops the guidelines, which are internationally recognized standards for treating cancer patients. He also is member of the International Myeloma Working Group, which develops guidelines for the diagnosis and treatment of myeloma and related diseases.
Clinical Trials
A clinical trial is a research study designed to evaluate a promising new medical treatment. It may involve a new way of preventing, diagnosing and/or treating cancer. Up to half of all Roswell Park patients are eligible to enroll in a clinical trial. Clinical trials may focus on:
- New ways of preventing cancer with drugs, diet and/or exercise
- New ways to better diagnose cancer (See Diagnostic Clinical Trials.)
- New drugs to treat cancer
- New ways to use existing treatments, such as surgery or radiation therapy
- New ways to improve quality of life for patients with cancer
For example:
- Chimeric Antigen Receptor T (CAR-T) Cell Therapy
As part of a clinical trial, and in partnership with Philip McCarthy, MD, Director of Roswell Park’s Transplant and Cellular Therapy Center, the Myeloma team offers CAR T- cell therapy for eligible patients with advanced multiple myeloma. In this treatment, the patient’s own T cells — part of the immune system — are collected, “re-engineered” to attack the myeloma cells, and then given back to the patient. This treatment option is very new and can be provided by authorized centers only.
- Therapeutic Cancer Vaccine
SurVaxM, a therapeutic cancer vaccine, is currently being evaluated in a phase I clinical trial as a treatment for patients newly diagnosed with multiple myeloma. The vaccine was developed at Roswell Park by Robert Fenstermaker, MD, and Michael Ciesielski, PhD. Kelvin Lee, MD, Chair of Immunology, is the Principal Investigator of the clinical trial.
When the information gained from a clinical trial shows that the treatment being studied is more effective than standard treatments, the new treatment eventually becomes the new standard of care. Every treatment that is now FDA-approved began as a treatment being studied in a clinical trial.
Search for multiple myeloma clinical trials now underway at Roswell Park.
Should I participate in a clinical trial? (Learn more about clinical trials from the National Cancer Institute.)
Proteasome Inhibitors
Proteasome inhibitors block the abnormal proteins or enzymes that stimulate the growth of myeloma cells. Examples of these drugs include bortezomib, carfilzomib and ixazomib. These are usually used in combination with other drugs.
— Typical side effects include polyneuropathy, which causes tingling, numbness or pain in the fingers and toes; diarrhea; orthostasis (dizziness when getting up too fast); and, very rarely, heart failure or difficulty breathing.
Immunomodulatory Drugs (iMiDs)
Immunomodulatory Drugs (IMiDs) activate the immune system to fight cancer. Usually the immune system recognizes that a cell is cancerous and kills it, but sometimes cells can escape. Immunomodulatory drugs reactivate specific parts of the immune system to effectively destroy those cells. IMiDs may include lenalidomide, pomalidomide or thalidomide.
— Typical side effects include increased risk of infection, blood clotting, diarrhea or constipation, fatigue, kidney problems and rash.
Antibodies
Antibodies are genetically engineered to zoom in on proteins that are found on the surface of cancer cells and destroy them. Daratumumab and elotuzumab are antibodies.
— Typical side effects include allergic reaction and increased risk of infection.
Histone Deacetylase (HDAC) Inhibitors
HDAC inhibitors help overcome resistance to other drugs. They block pathways other than those blocked by proteasome inhibitors and help activate tumor suppressor genes in the cell. Panobinostat is an HDAC-inhibitor approved for the treatment of multiple myeloma.
— Typical side effects include a weakened immune system, diarrhea, fatigue and nausea.
